Wiki Identifying Worldwide Emergency coverage claims

[losmus]

Medicare advantage plans have coverage for worldwide emergency services. How would these be coded? Is there a specific ICD-10 dx code, condition code, cpt to identify these claims? How would not having an NPI/TIN work?

 

[sls314]

Medicare advantage plans have coverage for worldwide emergency services. How would these be coded? Is there a specific ICD-10 dx code, condition code, cpt to identify these claims? How would not having an NPI/TIN work?

In my experience, the patient just submits the documentation from the service and a receipt of payment. If possible, I'd suggest translating the documentation into English. The insurance company then reviews and determines the reimbursable services that will be reimbursed back to the patient.

There isn't any coding done, because providers outside the US don't necessarily use the same coding systems. CPT is an American Medical Association code set, and in the US we use Clinical Modification of ICD-10. (Hence the ICD-10-CM.)

At least, that's the way it happened when I worked in customer service for an insurance company. All of our insured members had emergency coverage out of the US, so the question came up quite a bit.